Gluten during pregnancy in mothers related to risk of T1D in children

According to Danish researchers, observational data indicated that a maternal diet rich in gluten during pregnancy was linked to the risk of type 1 diabetes in children, but the evidence was not strong enough to warrant dietary recommendations.

In a study of more than 63,000 pregnant women followed for more than 15 years, the risk of type 1 diabetes in children increased in proportion to the intake of maternal gluten (hazard ratio 1.31, 95% CI 1,001- 1.72 per increase of 10 g / day). Other risk factors, including the mother's age, weight, and smoking, said Julie Antvorskov, PhD, of the Bartholin Institute-Rigshospitalet in Copenhagen, Denmark, and her colleagues.

Compared with children of mothers who consumed the least amount of gluten during pregnancy (less than 7 g / day), children of mothers who consumed the most gluten (more than 20 g / day) were twice as likely to develop type 1 2.00; 95% CI 1.02-4.00), the researchers reported online in BMJ.

"This magnitude is comparable to findings from other studies of other potential protective factors (breastfeeding and vitamin D3 supplementation) in infancy." However, additional evidence is needed before that changes to dietary recommendations may be justified in an intervention setting or in other cohort studies. "

In addition, the absolute risk of type 1 diabetes in the study cohort remained low: 0.37% overall and 0.52% in children born to mothers in the top 10% of the intake of gluten.

The team prospectively analyzed data on 67,565 pregnancies in 63,529 women enrolled in the Danish national cohort from January 1996 to October 2002. Maternal gluten intake was performed at week 25 of pregnancy. The average consumption of gluten was 13 g / day. Information on type 1 diabetes in children has been collected from the Danish Diabetes Registry for Children and Adolescents. Over an average follow-up period of 15.6 years, 247 children developed type 1 diabetes (0.37%).

Previous studies on maternal gluten and the risk of type 1 diabetes in children have produced contradictory results, noted Antvorskov and his co-authors. A study in mice revealed that the incidence of diabetes increased from 64% in mice fed gluten-free diet to 8%. However, no study examining the link between maternal gluten intake and islet autoimmunity in children has been reported.

"The incidence of type 1 diabetes is highest in Western countries and until recently it has increased by 3 to 4% per year, especially for children under 5 in Europe" , the researchers said.

"This increase is faster than can be explained by genetic drift, highlighting the importance of environmental factors.The gluten proteins present in wheat, rye and barley are considered important in the development of diabetes.They are rich in proline and glutamine, makes them highly hydrophobic and partially resistant to intestinal degradation.These properties make them more immunogenic than other dietary proteins, which are efficiently hydrolyzed to unique amino acids or dipeptides or tripeptides. "

The researchers noted that potential mechanisms linking gluten to type 1 diabetes include increased inflammation, increased intestinal permeability, and altered intestinal microbiota.

In an accompanying editorial, Maija Miettinen, PhD, and Suvi Virtanen, PhD, of the National Institute of Health and Welfare of Helsinki, Finland, highlighted some of the limitations of the Study and agree with the authors help pregnant women to reduce their gluten intake. "Since a causal association between maternal gluten consumption and type 1 diabetes in children has not yet been established, it is too early to alter dietary recommendations regarding the consumption of gluten during pregnancy. "

"However, physicians, researchers, and the public should be aware that the consumption of large amounts of gluten is harmful and that additional studies are needed to confirm or rule out these findings and to explore the possible underlying mechanisms."

In addition, the study did not determine whether mothers who ate large amounts of gluten also fed their children with a gluten-rich diet, or whether children were exposed to gluten through breast milk, said Miettinen and Virtanen. "Therefore, the study of Antvorskov and colleagues does not determine whether the possible side effects of gluten that may eventually trigger type 1 diabetes result from prenatal exposure, from Exposure in children or both. "

The researchers said that despite the large size of the study, statistical power was limited by the small number of children who developed type 1 diabetes. "In addition, the role of unmeasured or unidentified confounders can never be totally excluded from observational studies, so confirmation of our results in another comparable but independent dataset is warranted. "

1969-12-31T19: 00: 00-0500

Last update 09/19/2018